I Would Like to Shorten or Remove my Strut Graft. Is This Simple to Do? Can It Be Done Using a Closed Procedure?

Question

Two years ago I had an open rhinoplasty and my doctor gave me a strut graft that extended my tip out 4mm beyond my original length, and now I am left with too much projection, and a "point" that I never asked for.  I would like to get the strut graft removed, or at the very least, shortened. Is this a simple procedure? and could this be done with a closed rhinoplasty? Have you done this before? What was the outcome?

John M. Hilinski, MD · Answer

I would be hesitant about doing a revision of a strut graft with a closed approach. In my opinion, this should probably be done with an open revision approach to provide optimal visualization of this area. It is likely that the problem is not the actual strut graft but the actual positioning of the medial crura (surrounding cartilage structure) on the strut graft. Therefore, if you just remove the strut graft with a limited approach, there is a chance the tip will drop back more than desired.

Stuart H. Bentkover, MD (retired) · Answer

Are you sure it is the columellar strut graft that is causing the over projection? These grafts are almost routine in an open rhinoplasty. The purpose is to stabilize the tip over the long term. While they can be used to increase projection, usually other grafts are used also, eg an onlay tip graft or a shield graft. The columellar strut can be removed or shortened through a small incision on the side of the columella, but that may not let the tip come back predictably or accomplish what you want. Did your surgeon say this is what you need or is this your own conclusion? The best person to revise a nose is usually the original surgeon, because he/she knows exactly how, why and where are the grafts were placed. Happy to see your for an opinion on what you need. I would need to have the operative notes to review.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,

	Yes you can probably have you strut graft removed through a closed approach however, that may not be the cause of your overprojection. You may need additional procedures to de-project your tip.

	Best,

	Dr.S.

I Would Like to Shorten or Remove my Strut Graft. Is This Simple to Do? Can It Be Done Using a Closed Procedure?

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